HOT TOPICS

Barbara Russell RN, BSHSA, MPH, CIC

Barbara Russell, RN, MPH,

BSHSA, CIC

• No Relevant Financial Relationship Reported

DEFINITIONS

• Colonization is the presence of an organism

without visible clinical symptoms.

• Infection is the presence of an organism along

with associated signs and symptoms of

infection.

What are epidemic diseases?

Infectious diseases that attack many

people at the same time in the same

geographical area.

(Ebola)

What are endemic diseases?

Diseases that constantly present in a

local population, e.g. MRSA

What are pandemic diseases?

Worldwide occurrence

(AIDS)

Middle East Respiratory Syndrome

The Virus

PRIME SUSPECT

Number of confirmed cases of Middle East

respiratory syndrome coronavirus infection

(145 fatal and 391 nonfatal) reported by the

World Health Organization (WHO) as of

May 12, 2014, by month of illness onset —

worldwide, 2012–2014

Confirmed cases of Middle East respiratory

syndrome coronavirus (MERS-CoV)

infection (N = 536) (and deaths) reported by

the World Health Organization as of May

12, 2014, and history of travel from in or

near the Arabian Peninsula within 14 days of

illness onset — worldwide, 2012–2014

Third US case of MERS

If:

Respiratory symptoms,

*fever/cough are present

*Note, every patient with cough and fever needs a

mask.

And:

Recent travel to or contact with someone who has been in the

Middle East:

Saudi Arabia United Arab

Emirates(UAB) Qatar Oman Jordan Kuwait Yemen

Lebanon Bahrain

Iraq Syria Israel

Then:

Place mask on patient immediately

and start Airborne Isolation in a

Negative Pressure Isolation Room.

All Staff wears N95 mask while

interacting with patient.

MERS Patient Triage Plan

SIGNS and SYMPTOMS

• Fever (100° Fahrenheit or 37.7° Celsius, or

higher ). Take your temperature twice a day.

• Coughing

• Shortness of breath

• Other early symptoms to watch for are chills,

body aches, sore throat, headache, diarrhea,

nausea/vomiting, and runny nose

• Pneumonia

INFECTION CONTROL • Any patient seeking care for symptoms consistent with MERS-CoV

infection should be given a mask to wear and immediately placed in

a private room with the door closed until an isolation room can be

arranged.

• · Evaluation and care of the patient should be performed using

standard, contact, and airborne precautions while awaiting

confirmation of diagnosis.

• · Place a facemask on the patient whenever the patient is outside of

the isolation room.

• · Healthcare personnel should use eye protection in addition to

disposable gowns, gloves, and respiratory protection when entering

the isolation room.

• · Patient care equipment, such as stethoscopes and blood pressure

CU cuffs, should be dedicated to the isolation room.

Specimen Collection and

Shipping

• For suspected MERS-CoV cases, healthcare providers should

collect the following specimens for submission to

• the FDOH state public health laboratory following consultation

with FDOH: nasopharyngeal swab, oropharyngeal

• swab (which can be placed in the same tube of viral transport

medium), sputum, serum, and stool/rectal swab.

• Specimens can be sent using category B shipping containers.

Additional information is available at

• http://www.cdc.gov/coronavirus/mers/guidelines-clinical-

specimens.html.

Vaccine and Treatment

• There is no vaccine to prevent MERS-CoV infection at

the present time.

• · There is no specific antiviral treatment recommended

for MERS-CoV infection; medical care can help relieve

symptoms. For severe cases, current treatment includes

care to support vital organ functions.

• CDC, NIH and other agencies are working on

development of a vaccine and identifying a treatment

Transmission-based Precautions are to be Initiated as Follows:

Airborne Infection Isolation Room (AIIR) Precautions (aka

Respiratory Precautions)

• iv. Note: In the event a newly recognized virus that causes influenza is declared present in the US by CDC patients known or suspected to be infected with it should be placed on Airborne Isolation. All persons with direct contact with patient and/or exposure to the patient care environment, including being in the patient room or in a triage or examination room or other potentially contaminated areas are to wear an N95 respirator and wear goggles/face shield upon arrival and throughout the duration of the affected patient’s presence in the facility. Infection Control should be notified as soon as possible. In the event several patients are thought to have “new” virus refer to BHM Administrative Policy 581.06 Epidemic/Influx of Infectious Patients.

CHIKUNGUNYA FEVER

• Chikungunya virus is transmitted to people through

mosquito bites. Mosquitoes become infected when they

feed on a person already infected with the virus. Infected

mosquitoes can then spread the virus to other people

through bites.

• Chikungunya virus is most often spread to people by

Aedes aegypti and Aedes albopictus mosquitoes. These

are the same mosquitoes that transmit dengue virus.

They bite mostly during the daytime.

A mosquito acquires the chikungunya virus from a viremic host. Following an average

extrinsic incubation of 10 days, the mosquito is then able to transmit the virus to a naïve

host, such as a human. In humans bitten by an infected mosquito, disease symptoms

typically occur after an average intrinsic incubation period of 3-7 days (range 1-12 days)

SYMPTOMS

• Most people infected with chikungunya virus will develop some symptoms.

• Symptoms usually begin 3–7 days after being bitten by an infected mosquito.

• The most common symptoms are fever and joint pain.

• Other symptoms may include headache, muscle pain, joint swelling, or rash.

• Chikungunya disease does not often result in death, but the symptoms can be

severe and disabling.

• Most patients feel better within a week. In some people, the joint pain may

persist for months.

• People at risk for more severe disease include newborns infected around the

time of birth, older adults (≥65 years), and people with medical conditions such

as high blood pressure, diabetes, or heart disease.

• Once a person has been infected, he or she is likely to be protected from future

infections.

Diagnosis

• The symptoms of chikungunya are similar to

those of dengue, another disease spread by

mosquitoes.

• See your doctor if you develop the symptoms

described above.

• If you have recently traveled, tell your doctor.

• Your doctor may order blood tests to look for

chikungunya or other similar diseases.

Treatment

• There is no medicine to treat chikungunya virus infection or disease.

• Decrease the symptoms:

– Get plenty of rest

– Drink fluids to prevent dehydration

– Take medicines, such as ibuprofen, naproxen,

acetaminophen, or paracetamol, to relieve fever and

pain.

Precautions

Standard

Countries and territories in the Americas where

chikungunya cases have been reported (as of May 12th, 2014

Countries and territories in the Americas where chikungunya cases have been reported:

Anguilla, Antigua and Barbuda, British Virgin Islands, Dominica, Dominican Republic,

French Guiana, Guadeloupe, Haiti, Martinique, Saint Barthelemy, Saint Kitts and Nevis, Saint

Lucia, Saint Martin, Saint Vincent and the Grenadines and Saint Maarten.

Countries and territories in the Caribbean where

chikungunya cases have been reported* (as of August 5, 2014)

*Does not include countries or territories where only imported cases have been

documented. This map is updated weekly if there are new countries or territories that

report local chikungunya virus transmission.

Countries and territories in the Americas where chikungunya cases

have been reported* (as of August 5, 2014)

*Does not include countries or territories where only imported cases have been

documented. This map is updated weekly if there are new countries or territories

that report local chikungunya virus transmission.

Chikungunya virus disease cases reported by state –

United States, 2014 (as of August 5, 2014)

Florida 127 (26) 4 (100)

H7N9 infections in people and poultry in China

Sporadic infections in humans; many with poultry exposure

No sustained or community transmission

Prevention- Cough etiquette and hand hygiene

Influenza viruses constantly change and it’s possible that this virus

could gain the ability to spread easily

Droplet possibly Airborne especially for aerosol producing procedures

Avian Influenza A (H7N9) Virus

Symptoms of C. difficile

Symptoms include:

Watery diarrhea (at least three bowel movements per day for

two or more days)

Fever

Loss of appetite

Nausea

Abdominal pain/tenderness

What diseases result from Clostridium difficile infection?

pseudomembranous colitis (PMC)

toxic megacolon

perforations of the colon

sepsis

death (rarely)

How is Clostridium difficile acquired?

It is ingested

How is Clostridium difficile treated?

appropriate course (about 10 days) of antibiotics, including

metronidazole, vancomycin (administered orally), or recently approved

fidaxomicin.

TREATMENT OF SEVERE

RECURRENT CASES

• Fecal Microbiota Transplant (FMT) is a

procedure in which fecal matter, or stool, is

collected from a tested donor, mixed with a saline

or other solution, strained, and placed in a patient,

by colonoscopy, endoscopy, sigmoidoscopy, or

enema and some times through an NG tube.

Use Contact Precautions: for patients with known

or suspected Clostridium difficile infection:

– Place these patients in private rooms. If private rooms are not available, these patients can be

placed in rooms (cohorted) with other patients with Clostridium difficile infection.

– Use gloves and gowns when entering patients’ rooms and during patient care.

– Perform Hand Hygiene after removing gloves.

• Because alcohol does not kill Clostridium difficile spores, use of soap and water is more

efficacious than alcohol-based hand rubs after hands are dried apply the alcohol based

hand rub.

• Preventing contamination of the hands via glove use remains the cornerstone for

preventing Clostridium difficile transmission via the hands of healthcare workers;

• Continue these precautions until diarrhea ceases.

• Because Clostridium difficile-infected patients continue to shed organism for a number of

days following cessation of diarrhea, some institutions routinely continue isolation for

either several days beyond symptom resolution or until discharge, or bathe patient, dress

in clean gown, wipe down belongings and transfer to a new room.

• Hypochlorite-based disinfectants or an EPA approved product that kills spores is most

effective in preventing Clostridium difficile transmission

MULTI DRUG RESISTANT

ORGANISMS

(MDROs) MRSA VRE ACINETOBACTER BAUMANNII

PSEUDOMONAS

STREP PNEUMONIAE

CARBAPENEM-RESISTANT ENTEROBACTERIACEAE (CRE)

THE LIST GOES ON WITH NEW ONES BEING ADDED EACH YEAR

Carbapenem-resistant

Enterobacteriaceae (CRE)-

Definition November 30, 2012

• Escherichia coli, Klebsiella species, and Enterobacter species

that are intermediate or resistant to at least one carbapenem

(including imipenem, meropenem, doripenem, or ertapenem)

AND resistant to all third-generation cephalosporins tested

(ceftriaxone, cefotaxime, and ceftazidime)

OR

• Escherichia coli, Klebsiella species, and Enterobacter species

that test positive for carbapenemase production (by any

method [e.g., the Modified Hodge Test, disk diffusion, PCR])

CRE – Carbapenem-resistant

Enterobacteriaceae- KEY POINTS

• 4% of US hospitals and 18% of LTC had at least 1 CRE during first half of 2012

• One type of CRE infection has been reported in medical facilities in 42 states during last 10 years

• GRE can kill up to half of patients who get a bloodstream infection

• Most CRE are still healthcare-associated

What are extended-spectrum

β-lactamases (ESBLs)?

• ESBLs are enzymes that mediate resistance

to extended-spectrum (third generation)

cephalosporins (e.g., ceftazidime,

cefotaxime, and ceftriaxone) and

monobactams (e.g., aztreonam) but do not

affect cephamycins (e.g., cefoxitin and

cefotetan) or carbapenems (e.g., meropenem

or imipenem).

How long do pathogens persist on

inanimate surfaces?

• Survival of pathogens on dry surfaces

(range)

– S. aureus 7 days to 7 months

– Acinetobacter spp. 3 days to 5 months

– Klebsiella spp. 2 hours to >3 months

Kramer A, et al. BMC Infect Dis 2006;6:130; Hirai Y. J Hosp Infect 1991;19:191-

200

MENINGITIS

• Most cases of meningitis in the U.S. are caused

by a viral infection, but bacterial and fungal

infections also can lead to meningitis. Depending

on the cause of the infection, meningitis can get

better on its own in a couple of weeks — or it can

be a life-threatening emergency requiring urgent

antibiotic treatment.

• DROPLET Precautions till bacterial ruled out. Viral

• MASK to be worn by all when ever an LP performed

TECHNOLOGY

INFECTION PREVENTION and CONTROL - 2014

Hand hygiene monitoring

Cleaning Rooms

http://www.xenex.com/index.php?page_id=99

.

Rogers R Chest 2011;139:980-980

©2011 by American College of Chest Physicians

http://twitter.com/DrBradHolland/status/487726826215575552/photo/1

51

Questions